Medicines That Can Cause Vulval Dryness and Irritation
Vulval dryness isn't always hormonal. Some medicines irritate the tissue directly, others alter the skin's moisture barrier, and a fair few do both. The result can be soreness, itching, or a persistent raw feeling that makes getting dressed feel like more effort than it should.
Why Medicines Affect the Vulva
The vulva is skin, but specialised skin. It's thinner than most of the body, rich in nerve endings, and designed to stay slightly moist. Medicines can disrupt this in several ways: by drying mucous membranes, thinning the skin, changing its pH, or reducing blood flow to the area. Some drugs also alter oestrogen levels, which affects tissue elasticity and natural lubrication. When any of these shift, the vulva often lets you know.
Medicines That Dry Mucous Membranes
Antihistamines
Chlorphenamine, cetirizine, loratadine—anything that dries up a runny nose can also dry the vulva and vagina. It's usually mild and reversible, but if you're taking them daily for allergies, the effect builds up.
Decongestants
Pseudoephedrine and phenylephrine reduce mucus production everywhere, not just in your sinuses. Occasional use is fine, but prolonged courses can leave vulval tissue feeling tight and uncomfortable.
Diuretics
Water tablets such as furosemide or bendroflumethiazide reduce fluid throughout the body. That includes the vulva. If you're on long-term diuretics for blood pressure or heart failure, dryness may become persistent.
Medicines That Affect Skin and Circulation
Retinoids
Isotretinoin (Roaccutane) for acne or tretinoin for skin conditions can thin and dry skin all over, including the vulva. The effect is dose-related and usually improves after stopping treatment, though it can linger.
Corticosteroids
Prednisolone and hydrocortisone are prescribed for conditions like rheumatoid arthritis, asthma, inflammatory bowel disease, and lupus—anything where the immune system needs calming down. Long-term use thins the skin and impairs collagen production. The vulva becomes more fragile and prone to irritation, tearing, or slow healing.
Beta-Blockers
Propranolol, atenolol, and bisoprolol are commonly used for high blood pressure, heart failure, irregular heartbeats, or preventing migraines. They work by slowing the heart and reducing blood pressure, but they also reduce blood flow to peripheral tissues, which can include the vulva. Less circulation means less oxygen and nutrients reaching the skin, sometimes resulting in dryness or reduced sensation.
Antidepressants and Painkillers
SSRIs
Sertraline, fluoxetine, citalopram, and similar antidepressants can dampen the brain's hormone-signalling loop, which may reduce oestrogen output. Some women on SSRIs notice vulval dryness or reduced lubrication during sex.
Opioid Painkillers
Morphine, codeine, tramadol, and oxycodone suppress hormone production when used long-term. This can lead to vulval dryness, reduced libido, and general tissue thinning.
Cancer Treatments That Lower Oestrogen
Aromatase Inhibitors
Anastrozole, letrozole, and exemestane stop the body making oestrogen—that's the point when treating oestrogen-receptor-positive breast cancer. But vulval and vaginal tissues depend on oestrogen to stay supple and well-supplied with blood. Without it, they can become thin, dry, and easily irritated. Local oestrogen—estradiol cream or DHEA pessaries—can often be used safely alongside treatment, but always with oncologist approval.
SERMs
Tamoxifen blocks oestrogen in breast tissue but behaves unpredictably elsewhere. Some women notice no vulval changes at all; others develop dryness, itching, or discharge as the tissue becomes less responsive.
GnRH Agonists
Goserelin and leuprorelin, prescribed for endometriosis, fibroids, or certain cancers, temporarily switch off the ovaries. The effect is a chemical menopause, and symptoms—including vulval dryness—usually ease once treatment stops.
Chemotherapy and Radiotherapy
Both can damage ovarian function, causing oestrogen to drop suddenly. The vulva may become dry, sore, or prone to splitting. For some women, periods return months later and symptoms settle. For others, menopause arrives earlier than expected.
Other Culprits
Anti-Seizure Medicines
Carbamazepine, phenytoin, and topiramate speed up how quickly the liver breaks down oestrogen. This can result in irregular periods, dryness, and reduced effectiveness of hormonal contraception or HRT.
NSAIDs
Ibuprofen and naproxen are safe in moderation, but high or prolonged doses can briefly suppress ovulation and lower oestrogen. The effect reverses once you stop taking them.
Thyroid Medication
Over- or under-treatment of thyroid disease can unsettle hormone pathways, sometimes affecting vulval moisture and comfort.
Herbal Supplements
St John's wort increases liver enzymes that metabolise hormones, which can reduce circulating oestrogen and make HRT or contraception less effective. High-dose green tea extracts may have a similar, though milder, effect.
What to Look Out For
Vulval dryness from medication often appears as:
-
Persistent itching or soreness
-
A tight, uncomfortable feeling when walking or sitting
-
Stinging during urination
-
Splitting or irritation after wiping
-
Pain or discomfort during sex
If these symptoms start soon after beginning a new prescription, mention it to your GP or pharmacist. Dose adjustments or alternatives may be possible.
What Helps
Don't stop prescribed medication without speaking to your doctor first. There may be alternatives, or practical ways to manage symptoms while staying on treatment.
For short-term effects, a plain emollient balm on the vulva and an internal moisturiser (pessary or ring) can keep things comfortable until your body adjusts.
If the medication is long-term and can't be changed, ask about local oestrogen. Estradiol cream, pessaries, or DHEA pessaries often restore comfort safely, even during ongoing treatment—though you'll need your clinician's approval, especially if you're being treated for cancer.
Non-hormonal options include hyaluronic acid gels or plant-based moisturisers. These won't replace oestrogen's effects but can improve day-to-day comfort.
Lifestyle basics matter too: drinking enough water, eating healthy fats, moving regularly, and doing pelvic floor exercises all support tissue resilience and blood flow.
If you're on cancer medication, a menopause-trained GP or oncologist can advise on the safest approach.
In Short
Medicines keep us well, but some have side effects that show up in unexpected places. Knowing which drugs can affect the vulva means you can connect the dots early, speak up sooner, and get the right support without unnecessary discomfort.